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WASHINGTON (Reuters) — Coal companies need to make a “fundamental shift” in how they control exposure to coal dust in underground mines to address the recent surge in black lung disease rates, according to a federal report released June 27.

The National Academies of Sciences, Engineering and Medicine report found that even though coal operators largely comply with recently tightened rules requiring monitoring for coal dust, those measures may not be sufficient.

“There is an urgent need for monitoring and sampling strategies that enable continued, actual progress to be made toward the elimination of diseases associated with coal mine dust exposure,” said Thure Cerling, a biology professor at the University of Utah who helped write the report.

The report recommends that the National Institute for Occupational Safety and Health (NIOSH) and the Mining Safety and Health Administration (MSHA) improve monitoring and conduct studies on the causes of the resurgence in the disease, which had been nearly eradicated in the 1990s.

Cases of the incurable illness, caused by inhaling coal dust, are rising to levels not seen in decades as miners plumb the depths of played-out coal seams using heavy blasting equipment, according to government health officials.

A report by the Government Accountability Office released this month said the federal fund to help coal miners disabled by black lung disease will require a multibillion-dollar taxpayer bailout if Congress does not extend or increase the tax on coal production that funds it.

The coal industry has been lobbying Congress to ensure that scheduled reduction in the tax it pays into that fund goes forward, arguing the payments have already been too high.

The National Academies of Science report says that it is unclear if tougher regulations around coal dust implemented by MSHA in 2014 are effective because many miners with black lung disease got the ailment from exposure that occurred years earlier.

“It is important to note that compliance with regulatory requirements by itself is not an adequate indicator of the rule’s effectiveness,” the report said.

The report also notes that while the 2014 rules called for the use of continuous personal dust monitors — devices that warn miners if dust concentrations are too high — “only a small fraction of miners are required to use” one during a shift.

Research and development efforts will also be crucial for better understanding the effects of changes in mining methods on miner health.